Irritable Bowel Syndrome: Therapies and Diagnosis

• Irritable Bowel Syndrome (IBS) is a significant health concern due to its high prevalence, substantial impact on individuals, and considerable economic costs.
• IBS is characterized by abdominal pain linked to changes in bowel habits.
• A common symptom of IBS is bloating, but is not essential for diagnosis.
• Individual symptoms alone aren't reliable for diagnosing IBS.

Clinical Features

• Abdominal pain must be present to diagnose IBS.
• IBS pain can either worsen or improve with bowel movements and is linked to changes in stool frequency and consistency
• Pain location is unpredictable, tends to wax and wane, and may be worsened by eating.
• Pain is most commonly felt in the lower abdomen
• Life events or difficult situations commonly exacerbate IBS pain.
• Continuous pain unrelated to bowel movements or triggered by menstruation, urination, or physical activity is less likely due to IBS.
• IBS can be categorized by the predominant stool pattern: constipation (IBS-C), diarrhea (IBS-D), or a mix of both (IBS-M).
• Stool consistency is often irregular and stool patterns can shift over time.
• Descriptions of "constipation" and "diarrhea" can vary among individuals, necessitating a clear understanding of their specific experiences
• The Bristol Stool Form Scale offers a way to objectively categorize stool form.
• Bloating affects a majority of IBS sufferers, the location can be unclear.
• It can greatly affect patients, especially those with IBS-C.
• Visible abdominal distension is more common in women.
• Distension tends to worsen as the day progresses.
• Distension involves abnormal diaphragm function, intercostal muscle contraction, and abdominal wall relaxation as an involuntary response.
• Bloating and distension can correlate with somatoform symptoms.
• Respiratory-targeted biofeedback can provide relief for some patients.
• Other symptoms can support IBS diagnosis, but are not definitive on there own.
• Individuals with IBS are more likely to experience upper abdominal discomfort or pain.
• GERD is more common in IBS patients.
• Extraintestinal symptoms are more common in patients with IBS: headaches, backaches, joint pain, sleep disruption, chronic fatigue, dizziness, palpitations, and dyspareunia.
• Symptoms should be present for at least 6 months for a confident IBS diagnosis.
• IBS can occur alongside other chronic conditions.
• Transient bowel symptoms can occur in healthy individuals as well as those with IBS due to a number of reasons, distinguishing these from chronic IBS symptoms is important.

Physical Examination

• Physical examination in patients with IBS is usually normal, although tenderness upon deep palpation over the colon may be appreciated.
• When abdominal pain is present, abdominal wall pain should be ruled out.
• Tensing the abdomen lessens tenderness from intra-abdominal sources.
• Increased tenderness with tensing may signify localized abdominal wall tenderness.
• Ovarian cancer should be considered in middle-aged or older women with new IBS-like symptoms, especially abdominal distension.
• A pelvic examination may be necessary to rule out an irregular, fixed pelvic mass.

Epidemiology

• IBS affects up to 1 in 10 individuals worldwide.
• Prevalence rates vary significantly based on the applied diagnostic criteria.
• IBS is less common in the elderly, but prevalence increases with advancing age.
• IBS in older adults may be underdiagnosed or misdiagnosed, potentially as diverticular disease.
• Gender-specific prevalence rates are higher in women.
• This gender difference isn't observed in South Asia, South America, or Africa.
• Increased healthcare-seeking behavior among women helps explain the gender differences.
• Men are more likely to report diarrhea, while women more often report constipation.
• Compared to men, women have greater rectal sensitivity, slower colon transit, and smaller stool outputs.
• IBS prevalence is generally similar among whites and blacks, data suggest it may be lower in Hispanics compared to non-Hispanic whites.
• Rome IV criteria categorizes IBS by stool form.
• IBS can be divided into the following, IBS-C, IBS-D, IBS-M, and the remainder cannot be classified (IBS-U) .
• The classification of IBS can prove to be complicated due to a lack of stability of these subgroups over time.
• Distinct subgroups may also classify by GI and noncolonic symptoms, and mood.
• The authors speculated that these novel subgroups may help direct therapy, with patients who have evidence of somatoform behavior and psychologic comorbidity receiving centrally directed therapies, and those with GI symptoms alone receiving treatments for constipation or diarrhea

Incidence and Symptoms

• Incidence of IBS in not well reported.
• Symptoms include diarrhea, constipation, bloating
• IBS can resolve by it self with symptoms returning at a later time.

Impact on Quality of Life and Costs

• There is convincing evidence that IBS decreases health-related quality of life.
• Poor quality of life may increase risk of IBS.
• IBS is associated with high costs due to missed workdays, decreased productivity, healthcare visits, diagnostic tests, and medication use.

Healthcare

• Healthcare is important for planning appropriate management strategies.
• Understanding why a patient presents for care is important in terms of planning appropriate management strategies

Risk Factors

• A key factor for IBS, is infections gastroenteritis.
• Such infections can be protozoal, bacterial, and viral gastroenteritis.
• Risk is higher with female gender, pre-existing psychological condition such as anxiety, and depression.
• Other factors include affluent childhood, antibiotic use, food intolerance, and poor quality of life.

Pathophysiology

• Numerous pathogenic mechanisms are involved, including altered motility, visceral hypersensitivity, abnormal gas handling and abdominal accommodation, low-grade mucosal inflammation, immune activation, and altered intestinal permeability.
• IBS may require multiple factors to manifest.

Altered Motility

• Diarrhea can occur through colonic mechanisms such as propagated contractions, enhanced gastrocolic, or rectal hypersensitivity.
• Constipation happens due to segmental contractions, reduced propagated contractions, or reduced rectal sensation.

Explore evidence-based therapies for Irritable Bowel Syndrome (IBS) and the significance of disease-modifying treatments. Understand the role of meta-analyses and clinical features in diagnosis. Review the importance of epidemiology and pathophysiology in IBS management.